MEDICARE: GOOD SHEPHERD MEDICAL CENTER - LINDEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	282NC0060X	Critical Access Hospital	008221	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0004NP	OTHER	TX	BLUE CROSS/PROFESSIONAL PROVIDER #
3	HH0386	OTHER	TX	BLUE CROSS PROV#

General Provider Information

NPI Number	:	1780649509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD MEDICAL CENTER - LINDEN INC

Provider Business Mailing Address
First Line	:	404 N KAUFMAN ST
Second Line	:
City	:	LINDEN
State	:	TX
Zip	:	75563-5234
Country	:	US
Telephone Number	:	903-756-5561
Fax Number	:	903-756-3718

Provider Business Practice Location Address
First Line	:	404 N KAUFMAN ST
Second Line	:
City	:	LINDEN
State	:	TX
Zip	:	75563-5234
Country	:	US
Telephone Number	:	903-756-5561
Fax Number	:	903-756-3718

Authorized Official
Title or Position	:	CEO
Name	:	EDWARD BANOS
Credential	:
Telephone Number	:	903-315-2000

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	02/09/2010

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